Could Monoclonal Antibody Treatment Be a Game-Changer for People with Weakened Immune Systems? Here’s What Cancer Patients Need to Know

These treatments are intravenous infusions or shots that can provide immunocompromised people with the Covid-fighting antibodies that their bodies do not produce on their own. Monoclonal antibodies are laboratory-made proteins that mimic the immune system's ability to fight off harmful pathogens such as viruses, according to the Food and Drug Administration.

If given via infusion, patients receive this treatment once, and the process takes about an hour. If given via shot, the antibody is administered as two separate consecutive intramuscular injections (one injection per monoclonal antibody, given in immediate succession), and may be effective for pre-exposure prevention for six months.

These types of treatments have already been used to keep Covid patients from experiencing more extreme complications.

How Can This Treatment Help Cancer Patients?

The U.S. Food and Drug Administration’s latest approval could lend some insight.

On Wednesday, the FDA issued an emergency use authorization for AstraZeneca's Evusheld (tixagevimab co-packaged with cilgavimab), which is a long-acting monoclonal antibody treatment, for the pre-exposure Covid prevention in certain adults and children (12 years of age and older weighing at least 88 pounds.)  Think of this treatment as an alternative to the Covid vaccine for patients who are immunocompromised or allergic to the traditional Covid vaccine.

Dr. Heather Yeo, a surgical oncologist at New York-Presbyterian/Weill Cornell Medical Center, tells SurvivorNet that this new approval is “interesting.”

“The question is really for whom this would be helpful. (The) vaccine is obviously more important. But for those who are allergic or who are unable to mount an immune response, this seems to offer promise,” she adds. “It's basically like giving your body the antibodies it needs to fight. So again, (the) vaccine (is) better.”

Dr. Stephen Freedland offers some tips for supporting your immune system during the Covid-19 pandemic.

"Vaccines have proven to be the best defense available against COVID-19. However, there are certain immune compromised individuals who may not mount an adequate immune response to COVID-19 vaccination, or those who have a history of severe adverse reactions to a COVID-19 vaccine and therefore cannot receive one and need an alternative prevention option," Dr. Patrizia Cavazzoni, director of the FDA's Center for Drug Evaluation and Research, said in a statement. "Today's action authorizes the use of the combination of two monoclonal antibodies to reduce the risk of developing COVID-19 in these individuals."

Right now, Evusheld is authorized in the United States for those who are not currently infected with Covid-19 and who have not recently been exposed to the virus, or someone with the virus. The authorization also requires that individuals either have a “moderate to severely compromised immune system” due to a medical condition or due to taking immunosuppressive medications or treatments people like cancer patients and may not mount an adequate immune response to the Covid vaccine.

Cancer patients have a weakened immune system due to the disease infecting their body, and if the patient is going through treatment, drugs (like chemotherapy) can weaken their immune system even further. (Surgery, radiation, targeted therapy, immunotherapy and stem cell transplants can all sometimes make a patient’s immune system less effective at fighting infections or viruses.)

Related: Two-Thirds of U.S. States Didn't Prioritize Cancer Patients Getting the Covid-19 Vaccine During the National Rollout, New Research Shows

Where Can I Get Monoclonal Antibody Treatment?

Officials at Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston, MD Anderson Cancer Center in Houston and Memorial Sloan Kettering Cancer Center in New York City confirm that these facilities are offering a monoclonal antibody treatment to vulnerable patients exposed to Covid. (Keep in mind, the new FDA authorization is only for immunocompromised people who have not been exposed to Covid.)

Dr. Meghan Baker of Dana-Farber Cancer Institute and Brigham and Women's Hospital tells SurvivorNet, "Dana-Farber has a protocol for monoclonal antibody post-exposure prophylaxis for patients at high risk for progression to severe Covid-19 and who are not fully vaccinated or are not expected to mount an adequate immune response to vaccination with a high risk exposure."

For some cancer patients, booster shots and third doses of the vaccine aren’t enough to protect from contracting Covid.

Dr. Emily Nachtigal, an Olive View-ULCA (University of California at Los Angeles) hematology and oncology fellow, tells SurvivorNet that a majority of cancer patients are immunocompromised due to their "underlying cancer or the treatment they are receiving." This is important to note because immunocompromised patients are at increased risk of complications from influenza and Covid-19, such as pneumonia or hospitalization.

Covid Vaccine Proven to be Less Effective in Cancer Patients Receiving Treatment

Research has shown that Covid vaccines are less effective in some cancer patients receiving chemotherapy, immunotherapy, biological therapy or any combination of the three. But that doesn’t mean cancer patients shouldn’t get the vaccine.

According to Dr. Nina Shah, a hematologist at the University of California San Francisco, it's critical that cancer patients going through active treatment get the booster after initial vaccination. "It's very important (to get your booster shot), since we know some cancer patients do not mount a sufficient immune response after the first series of shots," she adds.

SurvivorNet experts advise cancer patients get vaccinated against the virus. It’s also encouraged that everyone, cancer patient or not, get vaccinated in order to help protect cancer patients from potentially contracting the virus.

Breast Cancer Survivor Julia Louis-Dreyfus, 60, Says If You Really Want To Help Cancer Patients, Get Vaccinated

Vaccines work by prompting the body to develop antibodies to fight a disease. Then, when the body encounters the actual disease, it has the tools it needs to fight back. For people with compromised immune systems, however, their bodies may not mount a sufficient immune response to a vaccine. This means that they may not develop enough antibodies to protect them from the disease, and they will remain vulnerable.  This is where monoclonal antibody treatment could help.

Some immunocompromised people are receiving third doses of the Covid vaccine in an attempt to develop adequate antibodies. (Booster shots, not the same as third full dose, are used to retrain the immune system after the immunity from the initial vaccine has faded.)

A pair of studies published in The Journal of the American Medical Association show that cancer patients have fewer antibodies than individuals who are not immunosuppressed when they first receive the vaccine, and after their second dose.

The first of these studies examined the antibody levels in patients with solid tumors on active anti-cancer treatment versus healthy controls in the weeks after receiving the second dose of the Pfizer vaccine.

There was some good news for cancer patients, with 90% of the participants registering as seropositive meaning a blood test showed evidence of Covid antibodies 5.5 weeks after the second dose and 87% four months after that final vaccination. In comparison, all 66 controls were seropositive for Covid antibodies both 5.5 weeks and four months after they received the second dose of the vaccine.

The big difference was in the level of antibodies present in cancer patients versus the healthy controls.

Cancer patients had about a quarter of the antibodies that healthy individuals did after 5.5 weeks and then a little less than a third after four months. Cancer patients had lost 78% of their antibodies after four months while the healthy control lost 82% between the two tests.

Contributing: Joe Kerwin

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